Gender-Based Violence Against Adolescent and Young Adult Women in Low- and Middle-Income Countries

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Purpose: Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, pol- icies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent and young adult women using Demographic and Health Surveys across low- and middle-income countries.

Methods: National prevalence estimates were generated among adolescents (15e19 years) and young adults (20e24 years) for lifetime and the past-year physical and sexual IPV among ever-married/ cohabitating women (30 nations) and forced sexual debut among sexually experienced women (17 nations). Meta-analyses provided regional estimates and cross-national comparisons, and compared the past-year IPV prevalence among adolescent and young adult women to adult women.

Results: An estimated 28% of adolescent and 29% of young adult women reported lifetime physical or sexual IPV, most prevalent in the East and Southern Africa region. Regional and cross-national variation emerged in patterns of violence by age; overall, young adult women demonstrated higher risk for the past-year IPV relative to adult women (meta-analysis odds ratio, 1.20; 95% confidence interval, 1.10e1.37) and adolescents had a comparable risk (meta-analysis odds ratio, 1.07; 95% confidence interval, .91e1.23). Forced sexual debut was estimated at 12% overall, highest in the East and Southern Africa region.

Conclusions: GBV is pervasive among adolescent and young adult women in low- and middle- income countries. The unique risk to youth varies across nations, suggesting an ageeplace inter- action. Future research is needed to clarify contextual determinants of GBV. Findings provide direction for integrating youth within GBV prevention efforts. 

Current findings offer pragmatic guidance in considering and responding to GBV among youth. In some settings, such as India, Bangladesh, Bolivia, and Peru, youth are disproportionately affected by IPV, suggesting that GBV efforts should target youth specifically both for prevention and for survivor support. Else- where, in both the East/Southern and West/Central regions of Africa, home to the highest observed prevalence of lifetime IPV among adolescents and young adults, no differences in risk were detected based on age. Forced sexual debut was also most prevalent in these regions. In such settings, national responses may consider pursuing more general prevention and support efforts, ensuring the inclusion of youth but not targeting them specifically. Together, findings emphasize the need for practi- tioners and policymakers to consider both the unique risk to youth and the overall prevalence of GBV, in prioritizing inter- vention and support efforts. 

Age-related vulnerabilities, such as relative inexperience and limited social standing, may in some settings interact with gender-based vulnerability to heighten risk for violence. In Bangladesh for example, adolescents demonstrated a threefold increased odds of IPV relative to their adult counterparts. Bangladesh is distinct in having one of the highest rates of child marriage globally; [39] the IPV heightened risk observed may reflect gender-based power inequities that are reinforced by young age [15]. In other settings, gender-based vulnerabilities and broader indicators of social and political un- rest may overshadow age-related vulnerabilities. For example, the highest IPV prevalence was identified in the DRC, although youth were not found at significantly elevated risk. The DRC’s extensive genocide and protracted conflict, with sexual violence endemic as weapon of war [40], may overshadow young age in imparting risk for violence. 

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